Findings from CaliforniaStatewide Surveys: Overweight
and Related Variables
Angie Jo Keihner, MS, Alyssa Ghirardelli, MPH, RD
Cancer Prevention and Nutrition Section, Public Health Institute
California Childhood Obesity Conference January 24, 2007
California Children’s Healthy
Eating and Exercise Practices Survey
(CalCHEEPS)
CalCHEEPS Funding• United States Department of
Agriculture Food Stamp Program
• The California Endowment
• California Department of Foodand Agriculture
CalCHEEPS Survey Purpose
• Fills a monitoring gap– No comprehensive statewide
surveys on nutrition for 9- to 11-year-old children
• Includes dietary practices; physical and sedentary activity; out-of-home eating; weight status; environmental factors; knowledge, attitudes, beliefs; PP! Campaign awareness
CalCHEEPS Sample Selection
• Market research panel households
• Quota sampling based on Current Population Survey
• Demographically representative
• English-speakingsample
CalCHEEPS Administration
• Years: 1999, 2001, 2003, & 2005
• Conducted April-June/July
• Parent-assisted 2-day food and physical activity diary: Mailed, filled out, and returned
• Unassisted follow-up telephone interview (14 mins)
CalCHEEPS Sampleand Response Rate
• ~2000 qualified households
• Returned food/activity diary
– N = 814, 754, 632, & 712
– 41%, 35%, 29%, & 32% response rate
• Completed telephone interview
– N = 394, 369, 379, & 400
– 51%, 53%, 68%, & 61% response rate
CalCHEEPS Strengths• Only detailed statewide measure of dietary
intake & PA among this age group
• Collects 2 days of diet and PA data
• Examine interrelationships between variables
• Examine ethnic and low-income segments
• Track changes in population over time;
• Track impacts corresponding to State legislation and/or PP! Campaign efforts
CalCHEEPS Limitations• Uses market research panel, not random
sampling – limits external validity• Complex and lengthy journal• Collects only 9 key foods (10 in 2001/3/5)
– Simplified food details– Limited portion size quantification
• Little unstructured PA • Weekdays only• English language only• Self-report bias• Social desirability bias
CalCHEEPS ResultsAt Risk and Overweight Contines to Rise Among
California Children, 1999-2005 CalCHEEPS
3436
3840
1519 18
2219
1720 19
10
15
20
25
30
35
40
45
1999 2001 2003 2005
Year
Perc
ent o
f Chi
ldre
n
Total
Overweight
At Risk
** ***
Notes: ** p<.01, *** p<.001; BMI ≥ 85th percentile.
CalCHEEPS At Risk/Overweight Compared to State & National Data
1999 2000 2001 2002 2003 2004 2005
CalCHEEPS (9-11 y)1 34% 36% 38% 40%
Fitnessgram (5th grd, measured)2,3
33% 34% 34% 33% 33% 34%
CA PedNSS (5-<20 y, measured)1,4
36% 37% 38% 39% 40% 41% 41%
NHANES (6-11 y, measured)1,5
30% 32% 37%
Notes: 1BMI ≥ 85th percentile; 2Not within the healthy fitness zone.Sources: 3California Department of Education. California Physical Fitness Report, Summary of Results for 1989-99, 2000-01, 2001-02, 2002-03, 2003-04, 2004-05. http://data1.cde.ca.gov/ dataquest/page2.asp?Level=State&submit1=Submit&Subject=FitTest 4California Department of Health Services. Children’s Medical Services Branch. CHDP Information Notice 05-D. Pediatric Nutrition Surveillance System (PedNSS) Annual Reports for Calendar Year 2004; Table 18C: Summary of Trends in Growth and Anemia Indicators by Race/Ethnicity, Children Aged 5 to <20 Years, page 5. Run Date: 11-17-06. 5Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295:1549–1555.
CalCHEEPS ResultsGains in At Risk and Overweight Were Highest
Among Children Below 185% of the Federal Poverty Level, 1999-2005 CalCHEEPS
34
4745
49
3436
3840
3330
34 35
25
30
35
40
45
50
1999 2001 2003 2005
Year
Perc
ent o
f Chi
ldre
n ≤ 185%
Total
> 185%
** ***
Notes: ** p<.01, *** p<.001; BMI ≥ 85th percentile.
CalCHEEPS ResultsAt Risk and Overweight Decreases as
Household Income Rises, 2005 CalCHEEPS
61
53
4237 36 33
20
30
40
50
60
70
<$15K $15-<25K
$25-<35K
$35-<50K
$50-<75K
$75+K
Household Income
Perc
ent o
f Chi
ldre
n
Notes: p<.001; BMI ≥ 85th percentile.
CalCHEEPS Results• At Risk and Overweight was
positively related to the consumption of:– Fried potatoes– High calorie, low nutrient foods
• High-fat snacks• Sodas or sweetened beverages
CalCHEEPS Results
Foods
At Risk/ Overweight
vs. Not At Risk Sign.
1+ Servings of Fried Potatoes
14 vs. 8 percent p<.05
High Calorie, Low Nutrient Foods
4.2 vs. 3.5 mean servings
p<.001
High-Fat Snacks 1.1 vs. 0.8 mean servings
p<.01
Soda or Sweetened Beverages
1.4 vs. 1.0 mean servings
p<.001
3+ Servings of Soda or Sweetened Beverages
14 vs. 5 percent p<.001Notes: BMI ≥ 85th percentile.
The California Teen Eating, Exercise and
Nutrition Survey (CalTEENS)
CalTEENS Background• First comprehensive California-wide
survey on nutrition and physical activity for adolescents
• Developed by Research and Evaluation Unit of the Cancer Prevention and Nutrition Section - California Department of Health Services
• Based on: – California Dietary Practices Survey– California Youth Tobacco Survey– CDC- YRBSS (Youth Risk Behavior
Surveillance System)
CalTEENS Funding• The California Endowment
(1998, 2000, 2002)• USDA Food Stamp Program
(2002, 2004, 2006)• California Department of
Health Services(Partial 2006)
About CalTEENS• Telephone survey 30-35 minutes (RDD)• Administered biennially since 1998• 12-17 yr olds• Sample size aprox. 1200• About 250 questions• Self-reported weight and height, fruits &
vegetables, high and low nutrient foods, PA, school environment, behaviors and attitudes
• Verbal parental consent and adolescent assent
• English and Spanish languages
About CalTEENSResponse Rates
– 1998: 85%, 2000: 88%, – 2002: 60%, 2004: 61%
Variable Descriptors• Overweight
– BMI ≥ 95th percentile• At risk for overweight
– BMI ≥ 85th and < 95th percentile• Income related food risk
– Responded yes to hunger within the past 12 months and household participation in WIC or Food Stamps
CalTEENS Strengths• Only detailed statewide measure of
dietary intake and physical activity among this age group
• Representative sample• Examines interrelationships between
variables• Examines population segments-
race/ethnicity, age, gender, overweight, other health related behaviors
• Tracks changes in population over time• Tracks impacts corresponding to State
legislation and/or program efforts
CalTEENS Limitations• Single day, modified recall, semi-
quantified• Measures marker foods rather than food
group servings or nutrient values• Dietary/PA questions adapted from adult
surveys; not validated with teens; surrogate SES data
• Seasonality• Weighting reflects 1990 or 2000
demographics• Self-report bias; social desirability bias• English/Spanish only
Distribution of At Risk for and Overweight Status of California Teens Aged 12-17 Based on Body Mass Index
13 13 14 17
811 9
12
0
5
10
15
20
25
30
35
1998 2000 2002 2004
Perc
ent o
f Tee
ns
Overweight
At Risk
2124 23
29
(BMI ≥ 85th percentile 1998-2004 p<.001), (BMI ≥ 85th percentile 2002-2004 p<.01) (BMI ≥ 95th percentile 1998-2004 p<.001)
CalTEENS Trends
CalTEENS Comparison to National and other Statewide Data
Overweight (BMI ≥ 95th %ile)1998 1999 2000 2001 2002 2003 2004 2005
CalTEENS 8% 11% 9% 12%
CHIS 12% 12%
YRBSS (national)
11% 11% 12% 13%
NHANES 17%
Sex-and age-specific BMI ≥ 95th percentile based on the CDC growth chartsSources: University of California Los Angeles Center for Health Policy Research. California Health Interview Survey, 2003 Adolescent AskCHIS internet data query system In. Los Angeles, CA.Youth Risk Behavior Surveillance - United States, 2005. In: Morbidity and Mortality Weekly Report: Department of Health and Human Services Centers for Disease Control and Prevention; 2006. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295:1549–1555.
CalTEENS Trends
1517
2018
38
29 29
34
26
34
31
37
20 21
13
34
10
15
20
25
30
35
40
1998 2000 2002 2004
Perc
ent o
f Tee
ns
WhiteAfrican AmericanHispanicAsian/Other
Distribution of At Risk for and Overweight Status of California Teens 12-17 by Race/Ethnicity Based on Body Mass Index
(Latino BMI ≥ 85th percentile 1998-2004 p<.001), (Asian/Other BMI ≥ 85th percentile 1998-2004 p<.01, 2002-2004 p<.001),
CalTEENS Results
23
2726
35
0
5
10
15
20
25
30
35
40
2002 2004
Perc
ent o
f Tee
nsNo Income RelatedFood Risk
Experiencing IncomeRelated Food Risk
(BMI ≥ 85th percentile, with Income Related Food Risk 2002-2004 p<.05)
Income related food risk includes respondents with hunger in the past 12 months and participation in WIC or Food Stamps assistance programs
Distribution of At Risk for and Overweight Status of California Teens 12-17 by Income Related Food Risk Based on Body Mass Index
2004 Data: At Risk for and Overweight and Behavior
Foods
At Risk for and
Overweight(BMI ≥ 85%ile)
Not At Risk Sign.
No servings of fruits or vegetables
14% 9% p<.05
No servings of vegetables
56% 48% p<.01
Soda or sweetened Beverages (mean)
1.5 serv 1.1 serv p<.001
2+ Servings of soda or sweetened beverages
41% 27% p<.001
TV time 159 min 120 min p<.001
CalTEENS Results
Foods
Income Related
Food Risk Not At Risk Sign.
No servings of fruits or vegetables
14% 9% p<.01
No servings of vegetables
60% 48% p<.01
TV time 159 min 119 min p<.001
Soda or sweetened beverages (mean)
1.4 serv 1.1 serv p<.05
1+ hour of physical activity
53% 65% p<.01
CalTEENS Results2004 Data: Teens Experiencing Income
Related Food Risk and Behavior
Income related food risk includes respondents with hunger in the past 12 months and participation in WIC or Food Stamps assistance programs
CalCHEEPS and CalTEENS Conclusions
• At risk/overweight continues to rise among California children and teens
• Most prevalent among low-income and minority youth
• Associated with high calorie, low nutrient foods • Specifically for teens:
– low consumption of fruits and vegetables– TV viewing
Contact Information• For more information about the
– CalCHEEPS: Angie Jo Keihner [email protected]
– CalTEENS: Alyssa Ghirardelli [email protected]
– www.ca5aday.com
